No urine output- BUN, Creatinine WNL?

[KyPinkRN]

this past weekend i cared for a patient in severe respiratory distress-probable heart failure combined with copd exacerbation. he was placed on the bi-pap and given lasix, solumedrol and pain/nausea meds. after things settled down we inserted a foley... this was after 80 mg of lasix. there was no urine out of the foley so we took the first one out and reinserted... still none, so we irrigated with saline... nothing. pt had no urine output for several hours while he was in our care. what could have been the cause if it wasn't kidney related? could it be that his heart just wasn't pumping out the fluid effectively? i have been racking my brain trying to figure it out.

[cicatrixx15]

Obstruction of the urinary pathway?

[Turtle in scrubs]

Did you do a bladder scan?

[KyPinkRN]

i wanted to scan him, but being an orientee i got trumped... more important things to focus on i guess. had i still been on the floor i would have done it.

[jlr820]

Was this patient hypotensive (shocky, perhaps cardiogenic)? Most sources say you must have a MAP of at least 60 in order to perfuse organs (kidneys included). So his heart failure could have put him in ARF. Could he have BPH or some other obstruction in the GU tract (renal calculi)? Did they do repeat BUN/creatinine to look for elevations? Maybe the first result was normal, if he had JUST gone into acute renal failure...may require serial examinations so they can see if elevation begins to occur.

[scoochy]

Sounds like a candidate for a S/G catheter...maybe his heart needs a jump start start with a little Dobutamine?

[medicrn13]

Not uncommon for a pt in severe heart failure to not produce alot of urine, even with the use of lasix. I'm interested to know what the Ejection Fraction of the patient was.

Agree, maybe Dobutamine, Milrinone or Natrecor for a little inotropic backup.